Bumps and breaks: Inside the world of sports injuries
TWIN FALLS, Idaho (AP) — There was a fresh energy present on the campus of the College of Southern Idaho on Friday, Sept. 15, one that was not there over the summer. Students had returned to the college, and fans packed the gym for the first home athletic event of the year.
As the teams launched into fall sports competition, the biggest action around campus was the defending national champion volleyball team hosting its first set of matches of the season at an invitational tournament that included four other teams.
The gym was packed and spirits were high, The Times-News reported.
The matches ran all day, morning to evening, and one person was hard at work from the time the first athletes arrived to the time the lights turned off at night. He wasn’t a coach, he wasn’t an athlete, and he wasn’t an official.
Richard Bingham, CSI’s athletic trainer, spent his day tucked in the back recesses of the gym, taping ankles and feet, handing out ice and assessing injuries.
“My philosophy is that I’d rather be bored than busy,” Bingham said. “In my profession, that’s a good thing. It sucks doing paperwork, but it’s a lot better than treating athletes because that means they’re hurt and they’re not out there doing what they need to do.”
For a player, getting hurt means pain and frustration. For a coach, it means a change in strategy and an added burden for the rest of the squad. For a fan, it might mean seeing a drop in performance from their favorite team.
Much of the process takes place out of the public eye. Most people don’t see the physical and mental battles athletes fight to recover, and many are not privy to the efforts of doctors and trainers behind the scenes who work to get athletes back to full speed.
BEHIND THE SCENES
While athletes confront difficult physical and mental challenges due to injuries, they don’t go through that process alone. Athletic trainers and doctors are there to guide them.
Dr. Chad Johnson is a go-to person for many injured athletes in the Magic Valley. Employed by St. Luke’s, he is the only primary sports medicine practitioner in the area, and there are only approximately 3,000 others who can make that claim across the United States.
Johnson sees patients of all ages in Twin Falls and deals with injuries that are non-operative — meaning they don’t require surgery. That includes everything from concussions to ankle sprains to muscle strains.
Johnson’s office also has relationships with four local high schools — Canyon Ridge, Filer, Kimberly (his hometown) and Jerome — and with CSI, where he is the directing physician. He and his staff provide care at high school sporting events.
“Overall, we make sure kids are safe,” Johnson said. “When they get hurt, we pull them out, and if we can get them back in the same game, we will.”
The high school sports season, which runs from late summer through the spring, means more injured patients and more activity. But he said it’s gratifying when he’s able to return athletes to action and show them that taking time to do the recovery process correctly was worth it.
“That’s when the payback comes as a physician or an athletic trainer when they’re overall grateful that we did it right and they go back and play at peak performance rather than limp through their season,” Johnson said.
Similar to the physician’s day, an athletic trainer’s day at the office can be just as long.
Bingham arrives at CSI’s athletic facilities between 8 and 9 a.m. and is busy for most of the day. All of the school’s teams are practicing or working out in the fall, even the ones that haven’t started their season yet, so there are plenty of athletes to take care of.
The biggest rush of activity comes before each one of the team’s sessions, which are spread throughout the day. The athletes come to him to get taped up or receive pre-practice treatment. Then the window between 3 and 5 p.m. is a rush as all of the teams are finishing their workouts at the same time and coming to him with new injuries or issues.
There’s also the possibility that an athlete receives a significant injury and he has to spring into action.
When the Golden Eagles host a home event, Bingham often stays on site until 10 p.m. or later, dealing with any new injuries that come up.
Bingham works six-day weeks during the school year and receives only a few weekends off from fall through spring. But he enjoys what he does, especially the aspect of building relationships with so many different athletes.
“On our teams, we’ve got kids from Africa, South America, North America and Europe, so you get to meet people from all over the world,” Bingham said. “If and when I ever decide to travel, I can go and stay for free at all of their houses.”
No two injuries are the same. Depending on what part of the body is hurt and how badly, treatments range from a bag of ice to full-blown surgery and rehab. The type of sport the athlete plays dictates what kind of injury is likely to occur.
Football players are prime candidates for injuries because of the physical nature of the game. When athletes are running into each other at full speed, they can break bones, twist ankles and suffer concussions.
Other sports played on grass or turf fields, such as football and soccer, leave athletes especially susceptible to ankle and knee injuries, including catastrophic ACL (anterior cruciate ligament) tears. The ACL is one of four main ligaments in the knee and is important for stabilizing it for cutting and changing directions. It requires reconstructive surgery and sidelines the average athlete for nine to 12 months.
Basketball and volleyball players constantly pound their feet on the court as they run and jump, which can lead to knee, shin and ankle problems that can linger and grow into worse injuries.
But one particular sport with less movement and more standing around has injury risk, too: baseball.
MISHAPS ON THE MOUND
Baseball players aren’t actively colliding with each other like football players, and they aren’t moving as much as basketball or volleyball players. So where is the potential for injury?
The persistent use of the arm for a pitcher can lead to long-term soreness and injuries, especially if the pitcher is overused.
“There are a lot of safety measures that are put in place, pitch counts and other things to keep these kids safe,” Johnson said. “But regardless, when you’re trying to throw balls as fast as you can accurately over and over again, those pitchers hurt their elbows and their shoulders pretty regularly.”
Devin Kunz, the head baseball coach at Burley High School, compares the strain of pitching to money in a bank account.
“When you’re throwing overhand and you’re elevated on the mound, that’s basically a withdrawal from your bank,” Kunz said. “Every time you throw downhill and overhead, you are taking a little bit out of your bank account.”
That’s why Kunz and his staff have the team — which has won back-to-back Single-A American Legion state titles — do most of its throwing drills on flat ground. They put a lot of emphasis on long-toss, and their pitchers practice most of their throwing on non-elevated surfaces.
The Idaho High School Activities Association, the governing body for the state’s high school sports, has rules about how many pitches a player can throw in a single day.
For instance, a varsity pitcher is not allowed to throw more than 110 pitches in one day (if they hit the limit in the middle of an at-bat, they are allowed to finish off the batter). They are also not allowed to pitch on three consecutive days, regardless of how many pitches they have thrown over that span.
The rules also require a certain number of rest days depending on how many pitches the player threw. For the first 30 days of the season, a varsity pitcher must not pitch for three days after throwing 71 to 88 pitches per day. After those 30 days, the range moves from 86 to 110.
The IHSAA requires teams to log their players’ number of pitches on the website MaxPreps. If a team violates the pitch count rule, the game where the violation occurred results in a forfeit. If a team doesn’t report a game, the coach can be suspended for two games as a repercussion.
Kunz supports the rules in place that protect young players, even if intentional overuse isn’t a widespread problem. He said limiting the number of pitches someone is allowed to throw is better than limiting the number of innings. The time length of any particular inning can vary.
“I think most of the coaches, especially in our area that we know, they’re not going to tear down a kid’s arm on purpose or throw him every inning,” Kunz said.
The 12th-year Burley coach explained that one of the biggest risks of overuse of the arm is when a player specializes in baseball.
“When you only play one sport, whether you’re 10 years old or 15 or 17, and you’re using the same muscles year-round, you’re going to get some wear and tear there,” he said.
That’s why he encourages his players to be multi-sport athletes outside of baseball season.
Kunz fought his own battle with injuries when he was a baseball player. He understands the mental challenges of rehab and recovery.
After a playing career at Brigham Young University from 1989-90, the Texas Rangers drafted him, and he worked his way up to Double-A in the minor leagues. One game, after throwing a pitch, he felt discomfort in his arm, like hitting his funny bone on a doorknob. The injury was concerning enough that the training staff sent Kunz to Los Angeles for surgery.
“They put me under, and they said, ‘Listen man, if you wake up and one arm is wrapped up, that’s a good sign,’” he recalled. ”‘If you wake up and two arms are in bandages, that means you’ve got Tommy John, and that’s a whole year off.’”
Tommy John surgery replaces the UCL (ulnar collateral ligament) of the elbow, and the procedure requires removing a tendon from somewhere else in the body to use. Since Kunz’s surgery ended up requiring this, his recovery time increased.
“I remember waking up groggy, and I had both arms in the cast,” Kunz said.
His elbow eventually recovered after a year and he went on to pitch in the minor leagues again, but he dealt with nerve issues that kept him from getting back to his full potential.
The former player described rehabbing from the surgery as a mental grind. He said the hardest part was having to progress slowly and only do as much activity as the training staff recommended — even when he was tempted to do more.
“With athletes, that’s what got them there, that drive,” he said. “When you have to tell them to slow down, to chill out and relax, that’s hard. When you don’t feel good, it’s not that hard. But when you feel good, to put the brakes on, that’s hard.”
PREVENTION IS HALF THE BATTLE
The athletic trainer’s job isn’t to just provide care once an injury happens. It’s also to prevent injuries from happening in the first place.
Bingham said that his job is easier than some because CSI has fewer high-injury-rate sports than some other colleges. There’s less chance for catastrophic injury that way, though the school’s rodeo team offers some occasional gruesome injuries.
“Rodeo is as catastrophic as it gets,” he said.
But regardless of the sport, ankle sprains are a common fact of life, especially with sports played on a court, such as basketball and volleyball.
“Out here on the basketball court, a lot of times the biggest risk factor for an injury is a previous injury,” Bingham said. “The biggest factor for an ankle sprain is a previous ankle sprain. The more you have, the more likely you are to get another one.”
That’s why he strongly recommends ankle braces to CSI athletes. He also works with players to make sure they are warming up and cooling down properly and helps them stabilize their joints.
At the high school level, the IHSSA has made injury prevention a priority, too.
The organization and all member schools must adhere to a fall sports practice model. For fall outdoor sports that start practice in the summer heat (football, cross country and soccer), there are limits on practice time and the amount of recovery required between practices, since dehydration, heat exhaustion and heat stroke are all possibilities. Practices can’t be longer than two and a half hours.
When it comes to football, the physical nature of the game provides an opportunity for injury. States have their own rules about the amount of contact allowed at practice. In Idaho, that limit is 120 minutes per week. Contact is defined as a drill where the players are running at full speed either up to or through the moment of a hit.
Ty Jones, IHSAA executive director, said coaches use common sense in the way they practice today.
“The days of the coaches that would practice for five hours, line kids up, and go live-action scrimmaging for an hour or an hour and a half are done, and they should be done,” Jones said. “Coaches practice smarter now.”
The IHSAA also provides injury resources on its website, including a concussion recognition course that it worked with St. Luke’s Hospital to create.
While schools generally rely on athletic trainers from outside sources, like local medical and physical therapy providers, Jones said the coaches across the state are prepared and knowledgeable enough to take care of their athletes if the need arises.
“I always tell people that Idaho’s coaches are very well-trained in safety procedures,” Jones said. “They’re obviously not doctors, but they’re well-trained in safety procedures and looking out for the health and welfare of the kids.”
REACTION, RECOVERY AND RETURN
Even with preventive measures in place, accidents can still happen, and athletes get hurt. Both Johnson and Bingham said an athlete’s mentality plays an important role in the recovery process.
“Every patient I have wants to get better,” Johnson said. “When they want to get better, I just have to give them the tools, and they’ll will it to happen.
“The truth of the matter is when you’re taking care of someone that wants to get better and all you have to do is hold back the reins until they are, they get better fast.”
Bingham sees a lot of diversity in how CSI athletes react to their injuries. Some will come to him the moment they feel pain, while others will try to tough it out.
He said both reactions can be either harmful or beneficial, depending on the situation. He teaches the athletes to distinguish between pain and injury — and that if they don’t speak up about ailments and choose to let their problems linger, they can end up with worse issues down the road.
“If we would have gotten it taken care of right away, we could have altered your practice for a couple of days — then you would have been fine,” Bingham said.
If an athlete sustains a significant injury and returns to the field or court after surgery, he or she might not have full trust in the reconstructed ligament or tendon, said Dr. Tyler McKee, an orthopedic surgeon at St. Luke’s in Twin Falls who regularly performs surgeries for sports injuries.
“When they tore their ACL or their Achilles, they weren’t doing anything crazy,” McKee said. “It wasn’t anything they hadn’t done a million times. So it’s kind of a fear that it could happen again. It takes them a while to cut with that same power and confidence.”
IT CAN HAPPEN TO ANYONE
Preston native Julia Nartker, a volleyball player for Treasure Valley Community College in Ontario, Oregon, experienced that drop in confidence after she recovered from an ACL tear.
While Bingham taped her feet to help with her shin splints before a match at CSI’s tournament, Nartker recounted how she tore the ligament by jumping and landing awkwardly next to the pole on the court last season. She said the pain in her knee was some of the worst she’s ever felt.
“On a scale of 1 to 10, it was like a 20,” she said. “It was bad.”
She had reconstructive surgery on her ACL and was back on the court in time for her sophomore season, but she said there was some lingering doubt in her mind that her knee would hold up.
“It’s in the back of my mind that I don’t want to injure it again,” Nartker said. “I’ve been reassured by my doctor that it’s fine and it’s super strong, and I shouldn’t worry about it.”
McKee pointed out that successful recovery from an ACL tear is not only a matter of the reconstructed ligament healing.
“If the muscles aren’t strong enough, if their reaction time or their balance and stamina aren’t back, we hold them out longer,” the surgeon said. “We have a few patients who, their graft is ready, but they’re not ready.”
Injuries can strike any active athlete. Johnson said cheerleading is actually one of the sports that keeps him the busiest. Cheerleaders attend other sports year-round, so injury risk is constant, plus flying and stunting makes it a grueling activity.
No matter how many precautions and safeguards are in place, there’s only one way to completely avoid an injury, Bingham said.
“One thing I was told many years ago is that there’s only one thing you can positively do to prevent a sports injury, and that’s to not be anywhere near sports, even on the sideline.”
Information from: The Times-News, http://www.magicvalley.com